Psycho-Babble Psychology Thread 310812

I have just finished reading two extremely interesting books by Allan Shore, a psychoanalyst and neuroscientist, about the role of the right hemisphere in the development of mood disorders (Vol 1), and the role of that hemisphere in psychotherapeutic treatment (Vol 2).

In the first volume, the importance of the right hemisphere during the first three years of life was explained in great detail. It develops much faster than the left hemisphere, and is the part of the brain infants use to assess the safety of facial expressions and body language expressed by its caregiver. It does this very rapidly, in about 1/200th of a second. Once the assessment is made, messages are sent down to the amygdala and hippocampus (the centers for feeling and memory- with the amygdala specialized for fear). These centers, which altogether comprise the limbic system, in turn send messages down to the autonomic nervous system. If a fear message is sent, the body responds with increased heart rate, breathing and blood pressure. The infant feels and looks frightened, and will look away and try to avoid the gaze of its caregiver; if the fear is very extreme, the baby will freeze, go limp and hang its head down. If the message is one of "everything's OK", the infant will relax, respond with a happy look, try to move closer, etc.

In normal infant development, repeated reassuring non-verbal messages cause a part of the right hemisphere- the orbital frontal cortex- to develop well. This part can control the fear centers in the limbic system, so that, as the infant matures, it can calm itself easily after frightening incidents, and return easily to a state of well-being. But if the care-taking has been poor or inadequate, the orbital cortex does not develop as well, and the growing child has prolonged periods of limbic and amygdala-dominated fear and avoidance responses. In Vol 1, there were fascinating simultaneous photos of mother-infant pairs; it was amazing how very slight changes in the mothers' faces- disinterest, withdrawal, anger, over-intrusiveness, depression - could produce fear responses in the babies. The main point of this volume was that the kind of care-giving (mothering, almost always) which the baby receives determines the architecture of the right hemisphere by the age of three, and that "affect dysregulation" during this period determines whether the baby will grow up to have a mood disorder. He thinks that all the disorders of affect dysregulation are pretty much the same, whether they are called PTSD, BPD, anxiety or depressive disorders.

Well, it was pretty discouraging to read about the abnormal right hemisphere architecture in Vol 1! However, Vol 2 was much more encouraging. it was entitled "Affect Dysregulation: Psychotherapy and the Repair of the Self". In it, he described how all forms of psychodynamic psychotherapy, ranging from psychoanalysis to once a week psychotherapy- all the kinds of therapy which use the relationship and interactions between therapist and patient as the most important modality- actually physically repair the abnormal right orbital frontal cortex damaged during the earliest period of life. It's not done verbally, according to Shore, but in the same way that mothers and babies do it -in face-to-face interactions which takes place with split-second timing, below the conscious level. Only a minute or two later do the therapist and patient put words on to what has happened. The words are important, as they feed back from the left hemisphere to the right orbital frontal cortex, which possesses very simple language. However, the most important event is non-verbal: the right hemisphere of the patient communicating with the right hemisphere of the therapist- at lightning speed! He showed some amazing photos of functional MRIs of patients who had been treated for panic disorder, compared to a group with the same diagnosis who were still on a clinic waiting list. They were all given a big challenge- to give a speech before a group. The patients who had received psychotherapy had amygdalas which "lit up" only half as much as those who were waiting to receive it. This must be one of the first times that brain imaging has been able to prove the effectiveness of psychotherapy.

Thought you'd like to know!

Further thoughts: doesn't this make the hundreds of really heart-felt posts about the importance we place on the relationships with our therapists make a lot of sense? Instinctively, we all *know* how vital these relationships are to our well-being and future health.

So far, Shore has only written about what happens up to age 3. But he mentioned how often maternal neglect is followed by some sort of paternal abuse, whether emotional, physical or sexual, so I suspect there will be a Volume 3. But what he has written so far has convinced me that maternal neglect of some kind is enough to cause the whole range of mood disorders,which he calls "disorders of affect regulation".

In reply to Our Right Hemispheres, posted by Pfinstegg on February 8, 2004, at 2:54:12

Hi Pfinstegg

Thanks for that summary. Now I don't have to read the books:)

It wasn't till I was 48 and three years into therapy that I realised just how much that fear was at the core of my life. (I'd always known that I was too anxious about things, can I do this job etc., but that was a different level of fear.) Anyhow, I'd always lived and felt, without realising it, as though I was on a narrow ledge 20 ft down a sheer cliff, with the rock on one side and a bottomless abyss on the other and I must hang on tight *all the time*.

What happened in therapy was that the picture shifted and the sheer cliff became the flat solid ground safely beneath my feet, if you see what I mean. So now life may throw its normal unavoidable crap at me, but there isn't this huge irrational profound terror that was always there, but almost unrecognised (just as well!)

The picture of maternal neglect (I think my mother was probably very depressed amongst other things)and paternal abuse (emotional certainly, but I can't remember a thing from before age 5) fits the bill pretty well.

I think I'm just trying to say that the idea of psychological-neurological damage and repair seems pretty plausible. Sorry, I can't produce any MRI scans as evidence, but I bet my amygdala is a lot cooler, in every sense, than it used to be :). Also that the repair takes time but maybe it gets its own momentum. Also that it's not too late even when you're really, really old, like 53. (I sometimes feel like Grandma around here :))

In reply to Our Right Hemispheres, posted by Pfinstegg on February 8, 2004, at 2:54:12

Gee, maybe this is why my therapist is distressed that I make so little eye contact.

I was very much into eye contact with my first therapist - I think she felt that she was under a microscope. But our relationship fell apart - I felt abandoned by her like I did with my mother.

It has been so clear to me in the last 8 months with my new therapist that my eye contact behavior is completely different. I rarely look at him. I might look at him while he is talking, but I won't look at him when I am talking. I am afraid that he will see me pleading with my eyes. I guess I am afraid to see him reject my pleading.

It does make sense. Thanks for the insight.

So how does this work when the patient is on the couch - don't they miss all of this facial stuff? Does the patient project facial expressions onto the therapist (more of the blank slate concept)?

In reply to Re: Our Right Hemispheres » Pfinstegg, posted by Crooked Heart on February 8, 2004, at 5:58:02

It's so good to hear that you feel your amygdala is *cooler* after therapy.-(I'm not sure whether you are still having it or not), I am having the same experience- of finding out how chronically terrified I really am-like you, I didn't even know how much. I, too had a depressed mother, who was not around for long periods of time, but unfortunately also an alcoholic, extremely abusive father. Did you develop a really caring, trusting relationship with your therapist. and do you feel tht is what was most helpful to you? I, and I'm pretty sure lots of others, would love to know more about that, if you feel like sharing it. I would, especially, as I am having much more trouble trusting my therapist now than when I first began therapy a year ago. I think it's because we are in a lot closer touch with all the original fear, and it is spreading into my transference towards him. Rationally, I know he is the same very empathic, experienced therapist whom I chose, who is committed to my well-being and improvement, and whom I like so much, but the fear just seems to be such a huge problem right now. I know that is why I read these books- just to try to gain some understanding and hope about the situation.

By the way, I am right in your age category. so please don't feel that you are unusual in any way. By rights, I should be a grandmother, but have just a 27-year old son at the moment.

In reply to Re: Our Right Hemispheres » Pfinstegg, posted by fallsfall on February 8, 2004, at 9:44:19

Hi Fallsfall! You raised such a good point about lying down on the couch. In those books, Dr. Shore made a point of saying that he now does psychoanalysis (even 5 days a week) with the patient sitting up facing him. After what I read, I, too, decided to sit up and try to maintain eye-contact with my analyst. In some ways, it is harder than lying on the couch, where you can *escape* the eyes. My analyst is cool with that- very flexible. I told him that I wanted to accomplish the basic trust- what Shore called "earned secure attachment" before I lay down on the couch again. He is very flexible, as I mentioned, but I think he thinks there are some real advantages to the couch- the loosening of one's guard over what one says, the regression towards an earlier (maybe infant) state, where good new interactions can occur between the two of you-verbal and body-language sensing, mostly, but, as he pointed out, also visual, if one turns on one's side towards him, which is perfectly OK to do. He is alongside the head of the couch,not in back of it.

I really can empathize with your intense dependency feelings, as I have them, also, although at present, I often get into a terrified, dazed state where I hardly feel anything, other than wishing to be invisible. I do think that it is best to respect those feelings, and to allow yourself to feel them as fully as possible in his presence. You are entitled to your real feelings, which you are having for such good reasons. The eye contact is so hard- what if you decide their eyes are cold and uncaring? - but perhaps it really is the way towards getting that right hemisphere functioning better.

I hope you'll keep letting us know how things are going for you. I will, too.

In reply to Our Right Hemispheres, posted by Pfinstegg on February 8, 2004, at 2:54:12

That was very interesting. This board can be quiet mentally stimlating. Have you ever heard of RAD? Reactive attachment disorder. It develops from neglect and abuse at a very young age. Infants to 3 or 4 I think. These kids find it impossible to form an attachent to anyone. I think this ties into your right hemisphere info. terrics

In reply to Re: Our Right Hemispheres, posted by terrics on February 8, 2004, at 11:33:48

Yes I have. I think there are supposed to be several attachment styles- secure, two forms of insecure, and the worst category- completely unattached. But I think people- or infants- are supposed tomove back and forth between these various attachment styles, depending on how safe the moment appears to be. In Shore's book, he mentions the "attachment literature" quite a bit, and integrates that with how the therapist and patient gradually move from one of the insecure or unattached styles to the "earned secure attachment". He feels that mutual gaze is an essential part of doing this. And one of the really hopeful things- the right pre-frontal orbital cortex which he feels is central to the development of secure attachment is thought to remain "plastic" thtoughout life, and thus capable of becoming normal. Some good news for all of us having such a struggle with this!

In reply to Re: Our Right Hemispheres » Crooked Heart, posted by Pfinstegg on February 8, 2004, at 10:06:47

I'll try to answer your questions but it's a bit difficult to give details because the terror was so great and so irrational and definitely there in the transference, and if other people were feeling similarly I wouldn't want to maybe make it worse?

I did have the father and mother of all transferences (unintentionally appropriate choice of words :)), very attached/obsessed/whatever. Anyhow at one point in therapy I was OK during therapy sessions and totally my usual self when around other people, and completely, literally shaking in my shoes terrified when on my own. Without going into details, the fear was to do with believing that I mattered absolutely not at all to my therapist. Who was skilled and conscientious, and always kind and compassionate although at that time I couldn't let myself be 'warmed' by that. It was weird though, because I knew all those things perfectly well and yet there was this part of me that was prostrate with terror and anguish that she was a complete monster of indifference. What you describe does sound a bit similar?

Anyhow, losing that fear was the best thing that happened during therapy and the best 'inside of me' experience in my life. It wasn't till it was gone that I realised how frightened I'd been all my life. But it took time, and it still gets better. Now I'm afraid of physical pain or danger and have the normal worries for those I love but that's about it. (Touch wood someone, that last sentence is just asking for trouble!)

My therapist certainly wasn't perfect, although I idealised her (at the same time as believing for a while that she might be a callous monster!). She was reliable, tactful and kind, usually brave, not too many hang-ups of her own, or if she had she generally kept them out of the consulting-room well enough. She didn't always get it right, she always did her best. I'm not quite sure how it all worked, my therapist said she didn't know either (horticultural therapy, Gardenergirl?). It was enough and I'll always be grateful. But does that in some way answer your question about the caring trusting relationship?

Regarding things like eye-contact, I don't know. I used to lie on a couch so there wasn't much. To be truthful, my lying on the couch was more to suit my therapist's preferences than mine (being a Good Patient). My guess is that it was the repeated and most of the time not very dramatic experiences of kindness, reliability and acceptance that did the re-modelling, although now I wonder if maybe more eye-contact might have helped things along a bit?

Have you talked about your fear with your therapist, Pfinstegg? I was too scared at first in case my worst terrors were confirmed, and then oh happy day when I realised they were nonsense I sort of didn't want to. I wish I had now though.

I hope that this rambling's been of some help? Anyhow, please feel free to fire away any more questions.

In reply to Re: Our Right Hemispheres (long) » Pfinstegg, posted by Crooked Heart on February 8, 2004, at 14:45:03

Thanks, Crooked Heart! What you told me was very helpful, and it's so encouraging to know that someone has faced all the fears and then really got better- also, that it continues to get better. We don't actually hear that too often on these boards! Also, you also used the couch- I thought I was the only one. Right now, I think it's better for me to sit up, but I hope to go back to using the couch more when this crisis is (hopefully) over, or at least has calmed down.

I am very open and honest with him about the amount of terror I am experiencing during sessions, and he is very warm, supportive and understanding. I think he feels that it is due to such poor mothering, and also to abuse by my father that I don't remember. I agree with him.But, in the present, it takes, for me also, a terror of being rejected again by him. Even though it's very painful, I think he feels it is something I have to go through with him, and he is trying very hard to let me know that he is really there for me.. The fears seem to have become concentrated to the sessions with him, with me acting, if not always feeling, pretty OK the rest of the time.

Anyway, thank you so much for taking the time to reply at such length, and to offer me such encouragement. It means so much.

In reply to Re: Our Right Hemispheres (long) » Crooked Heart, posted by Pfinstegg on February 8, 2004, at 15:08:34

Reading this is so helpful. The right brain stuff is fascinating, and hits home for me.

For more than five years I have been in therapy.

For several years I thought of my psych as Mephistopheles, called him that to myself and my friends. And of course I told him. I had gone to a show of 19th century Polish paintings and there was one of a woman sitting at a table, her head in her hands, her posture one of defeat, and next to her sat a man, tipped back in his chair, smirking, seeming to take pleasure in the devastation of the woman. The man seemed like the devil to me. At the time, my T felt like that to me, that he sat watching me, questioning me, seeing me suffer and taking pleasure from it because he disdained me. Ah, transference...Then I began to believe that he did feel for me, that he was not insensible to my suffering, and that he cared. I don't know exactly how this shift took place, but the idea of eye contact and the development of an attachment makes good sense. Slowly, I began to trust his honesty, his caring, and his integrity. I spmetimes continue to be afraid when I go to see him, but my fear was more one of what the session would reveal than of any judgement from him.

The fear of life that sent me there has slowly abated. The fits of howling desapir where I wept and writhed in self-loathing have not bothered me for over a year. I am not nearly as reactive as I used to be as I understand better that my behavior often affects the reaction people have to me, and that the reaction people have to me often had nothing whatsoever to do with me. No, I am not contradicting myself!

All of my relationships are better.

It used to make me angry when I'd see my T's eyes redden when I was telling him something painful, and that touched him. It felt like he was too delicate to handle the hard parts. That feeling has passed.

I do wonder if I have to be nice. I want to yell at him sometimes still, something I have never done. I want to rail and howl at him, esp now that I am at the end of therapy. I was to throw great heaving tantrums a la 2 year old. (I stand in awe of those kids thrashing on the grocery store floor. What expression! What release! I envy them!)

In reply to much better, posted by shortelise on February 8, 2004, at 17:54:06

It is nice to know that "modern" science is now documenting what the birthing field has advocated for 40 years. We know that mothers need immediate contact with their babies when ever possible to begin the bonding process. And babies need secure, consistant care to begin their attachment. I would argue that touch and voice, soft, gentle, and appropriate, is just as important. Our babies who are blind attach to their caregivers through touch and voice. Think about how most of us instinctively sooth a baby - we rub their backs and talk softly. We don't usually make eye contact to sooth them. So it is the mix that is important.

I think, though, attachment can be disrupted by traumatic events later in life, especially the teen years. Sometimes if our expectations are to never be hurt or abandoned and it happens, things shatter. But perhaps these are easier to get over in some ways, if you had good care early on.

I agree with the eye contact making a difference, but I think voice is equally so. I find that when I'm saying something really important, there is usually eye-to-eye contact. I might break it and look away, but he never does. And when I look up, he is usually looking right at me, accepting the reconnection. When I'm relating an old memory, I mostly don't make eye contact, looking out the window or off into space. It is at these times that he usually interjects very soft, "I know" or "you're doing fine, keep going" etc. He doesn't interrupt or derail me, he just lets me know he is there with me. Does that make sense?

Even given how great I think he does things, I'm still insecurely attached. I fight it every week. But I know this is from the past. I'm hoping to get past it soon.

In reply to Re: Our Right Hemispheres (long) » Crooked Heart, posted by Pfinstegg on February 8, 2004, at 15:08:34

It sounds really good to me that you are able to experience the terrors when with your therapist (much better and more productive than alone, I can tell you, from experience with both!). You must have built up a lot of trust in him.

Might it help sometimes to think of what you're going through now like labour pains -- hurts like h*ll but a lovely baby at the end of it?

In reply to Re: Our Right Hemispheres (long) » Pfinstegg, posted by Crooked Heart on February 9, 2004, at 3:33:10

Thanks CR! That's a wonderful image to try to keep in mind, as my anxiety is building up fast- I'm due for my session with him in an hour. It's amazing (and wonderful) to me how much understanding and support people like you on this board have to offer. I know it helps me think much more clearly when i get engulfed in waves of terror. It's such a powerful. positive thing to be in contact with people who REALLY understand. My T, who is in his mid-fifties, and not especially Inter-net minded, is becoming very interested in what goes on in PB. He really seems to like it when i print out some of the exchanges we have here for him. I think he especially likes how well people here are able to attune to one another, and he appreciates not just my posts, but the responding posts. I notice my medical folder is getting quite fat with, I'm assuming, PB print-outs! I'm off now, keeping your lovely image in mind.

In reply to Attachment, posted by DaisyM on February 8, 2004, at 18:15:42

Your therapist just sounds better and better! Although sometimes a gentle encouraging voice could just about break me up.

I used to lie rigidly on my back onthe couch, hands folded, ankles crossed, but I did miss not being able to see my therapist -- I wanted to know she was *there* even when she wasn't saying anything! Once I began to realise that I mattered, I became seriously confident and used to lie comfortably on my side -- so now I could usually see foot and hem of skirt, and to this day I could still describe the sensible shoes!

With babies, I definitely agree that it's the mix of sight, sound, touch (and smell?) that is important. Lucky for us adults that understanding, empathy, conversation, phone calls, any other form of communication are also in the mix...?

In reply to much better, posted by shortelise on February 8, 2004, at 17:54:06

Hi Shorte, It is good to hear that therapy works for some people. I think 5 yrs is pretty quick. Tell your T. the thing you want to tell him. I called mine yesterday and blasted her for something she said. She said it was ok to be mad at her. I have been seeing this one for 2 years. Do you REALLY feel better??? terrics

In reply to Re: Attachment » DaisyM, posted by Crooked Heart on February 10, 2004, at 12:06:24

I can't believe I forgot smell! Yes, I think all those things are important. I still know what my mother's perfume smelled like when she was going out (leaving me)...it was different than her "everyday" perfume.

I too am glad we have all forms of communication as adult. But even with all the tools we have, it is interesting how we can misread people, or allow ourselves to be misread.

In reply to Re: Our Right Hemispheres (long) » Crooked Heart, posted by Pfinstegg on February 9, 2004, at 7:09:54

Hope the terrors subsided to a manageable level. Can I ask whether you see your therapist more than once a week? (Don't answer if that's nosey.) For some reason I used to find Monday sessions more stressful, or the run-up to them anyway.

In reply to Re: Our Right Hemispheres (long) » Pfinstegg, posted by Crooked Heart on February 10, 2004, at 17:52:52

Yes, thanks, sitting up and talking it through did bring a lot of the terror down to a much lower level. Actually daring to look him in the eyes, and see that there was a benign person there helped a lot. Now I am back to a half-up (the first part of the session) and half-down (the latter half). I think that there is no question about the couch helping to bring forth feelings and thoughts which might be automatically censored in a face-to-face position., so both ways seem to have very valuable things about them I see him Mondays and Thursdays, and it's true- the Monday session tends to be the hardest!

Have you actually terminated your therapy, or are you getting towards that? If you are, it would be a wonderful topic for a new thread here, as it's a dreaded issue for so many of us; some people here are also reporting very painful experiences of their own terminations. It would be wonderful to know more about the best ways of accomplishing it- for example, would *gradual* be best?

In reply to Re: Attachment » Crooked Heart, posted by DaisyM on February 10, 2004, at 17:13:38

Daisy, I haven't had a chance to respond to your posts, but you brought up a range of important attachment behaviors besides gaze-a soft voice, gentle touch, and a familiar smell! (that really is very powerful- I agree. I do wish I remembered my mother's perfume- especially her "going out" perfume, as you do). It sounds as though you may have worked with blind babies and seen how they use their senses to attach- that was fascinating.

I don't know, but I wonder whether all of these could be considered right hemisphere attachment behaviors. They weren't covered in Shore's books, so I'll need to continue my researches!

But, anyway, thanks for your posts. You've got an especially great therapist, from everything you have posted about him. With him, it sounds like you can have one of those intense, meaningful and life-altering experiences which you will always remember.

In reply to Re: Our Right Hemispheres (long) » Crooked Heart, posted by Pfinstegg on February 10, 2004, at 18:38:30

I'm glad the terrors subsided. And daring to look him in the eyes and see what you find is pretty good. (That sounds weird now I read over it, but you and I know what I mean :))

I actually finished therapy a while ago, but it was forced, although with 6 months' notice, as my therapist's long-term illness was getting worse and she had to retire. That was definitely a bad downside of therapy, although hugely outweighed by what I gained. However I contrived to put off facing the loss (that's a whole nother story!) for a long time. I am now doing that and just reading the posts on this board has been incredibly helpful. If I'd had the choice I'd have gone for gradual, but I put off everything...

In reply to Re: Attachment » DaisyM, posted by Pfinstegg on February 10, 2004, at 18:52:57

I have worked with all kinds of kids with disabilities. Actually our babies who are deaf had the hardest time bonding...isn't that strange? We encourage tons and tons of nursing so they get the sensory input. The little guys who are blind tend to cling, so they bond quickly. The parents have a harder time in that case because they need feedback (smiles, eye contact) from their babies to know they are "getting it right" and you don't get that from babies who are blind.

As far as my Therapist - yeah, I'll keep him. This has been an especially challenging month (couple of months) and he's been right there. I actually asked him yesterday if he was mad at me, because we were going over some of the same old abandonment issues. He said, "no, just worried about you." I told him not to worry. He said it was his job and I wasn't "allowed" to tell him what to do, even if I did boss everyone else around. :) It is nice that we can laugh together at some of this.

In reply to Re: Attachment » Pfinstegg, posted by DaisyM on February 12, 2004, at 10:46:48

What you said about babies who are deaf having the hardest time bonding. That is so strange, of course one would imagine sight to be the most important. The first thing that occurred to me was do babies hear their mother's voices when they're in the womb, maybe?